Provider Demographics
NPI:1629065149
Name:EARLEY, TIMOTHY W (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:EARLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4463 WEYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9249
Mailing Address - Country:US
Mailing Address - Phone:330-722-2150
Mailing Address - Fax:330-722-2055
Practice Address - Street 1:4463 WEYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9249
Practice Address - Country:US
Practice Address - Phone:330-722-2150
Practice Address - Fax:330-722-2055
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4924/T1794152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH410040999OtherMEDICARE RAILROAD
OH5408550OtherFIRST HEALTH
OH341704134TEOtherSUMMA CARE
OH000000230621OtherANTHEM BLUE CROSS/BLUE SH
OH5086030OtherCIGNA
OH0488300001OtherADMINISTAR FEDERAL
OH0863201Medicare PIN
OH5086030OtherCIGNA